A 2-year-old boy presents with painless rectal bleeding. Colonoscopy shows a solitary lesion in the distal ileum about 60 cm from the ileocaecal valve. Which set of features correctly describes this anomaly?
- A Occurs in 2% of the population, 2 feet from the ileocaecal valve, contains ectopic gastric mucosa, presents before age 2 years ✓
- B Occurs in 2% of the population, 2 inches long, contains ectopic pancreatic tissue, presents after age 5 years
- C Occurs in 20% of the population, 2 cm from the ileocaecal valve, contains ectopic colonic mucosa, presents in infancy
- D Occurs in 2% of the population, 2 feet from the duodenojejunal flexure, contains ectopic jejunal mucosa, presents at any age
Correct answer: A. Occurs in 2% of the population, 2 feet from the ileocaecal valve, contains ectopic gastric mucosa, presents before age 2 years
Explanation
Meckel diverticulum follows the rule of twos: present in about 2% of people, roughly 2 feet from the ileocaecal valve, about 2 inches long, containing two types of ectopic tissue, commonly gastric, and usually symptomatic before age 2 years. Ectopic gastric mucosa secretes acid causing ulceration and painless bleeding, and it is also what allows detection on technetium-99m pertechnetate scanning. The location is on the antimesenteric border of the ileum, never near the duodenojejunal flexure.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.